Thursday, June 09, 2016

Maintenance of Certification: Medicine's House of Cards

Background

In 1986 after struggling for years to secure a growing stream of revenue, the American Board of Internal Medicine (ABIM), a 501(c)(3) non-profit physician testing agency originally domiciled in Iowa and now located in Philadelphia, PA, unilaterally decided to make its once voluntary and lifelong Board certification credential time-limited. In 1986, the prospect of implementing universal healthcare (Hillarycare) loomed on the political landscape so there was a growing sentiment within the ABIM that its role should shift from determining a physician's excellence to practice medicine to assuring a physician's practice adequacy. By making this strategic philosophic change, the ABIM assured itself a new and virtually limitless revenue stream for years to come on a promise they knew how to determine such a metric.

There was only one problem: how does one define physician excellence?

Excellence in medicine is not easily defined. Is physician excellence defined by patience, empathy, intellect, experience, surgical dexterity, technical skills, or some combination of these things? Or might it be judged on something else entirely? Might the qualities of excellence from a general internist be very different from those of a specialist in internal medicine?

Such important questions did not concern the leadership at the ABIM. They were convinced that not only was it possible to define methods for measuring excellence, they would blaze the trail for this endeavor. To assist them, the leadership of the ABIM co-opted the nation's brightest scholars, lured by first-class airfares, the nation's most luxurious hotels, and elegant wine selections at dinner, to create more challenging and clever test questions for practicing physicians. None of these scholars complained. Many were honored to provide such a service; it was a great gig for those lucky enough to escape the mundane work of actually caring for patients while being wowed by the lavish creature comforts afforded to them.

On the other hand, working physicians on the front line of health care were caught completely off-guard by the unexpected unilateral "re-certification" rule change developed in December 1986 and ultimately implemented by the ABIM in 1990. Practicing physicians, accustomed to a lifetime of testing and unaccustomed to strongman tactics and political pandering that threatened "uncertain consequences" if they did not participate, never questioned the rationale for the rule change. For most doctors, the change was seen as just another test they needed to pass to keep working despite never being independently shown to improve patient care or outcomes.

That is, of course, until practicing physicians slowly awakened to the gravity of the ABIM's rule change if they failed re-certification: there was a very real possibility that they might find themselves no longer "Board certified" and could lose their license to practice medicine, hospital admitting privileges, or ability to receive insurance payments. They were cleverly trapped. What choice did they have other than to participate?

Empowered by the significant additional revenues garnered by re-certification and a politically lackadaisical physician workforce, the leadership of the ABIM and the American Board of Medical Specialties (ABMS), along with the many friends they secretly lobbied on Capitol Hill, were asked to deliver even more for their undisclosed corporate clientele: Premier, Inc., CECity, Kaiser Foundation Health Plans and Hospitals, the IPC The Hospitalist Company and their close-held relationships with the Center for Medicare and Medicaid Services (CMS). The leadership at the ABIM decided to expand their definition of physician "excellence" to include the concept of "medical professionalism." This way, a health care cost-saving imperative could be levied on physicians, too.

But medical professionalism, like medical excellence, was not easily defined. Like pornography, the leadership at the ABIM just knew it when they saw it.

Never deterred, the ABIM convened a "writing group" funded by $59,618,428 in assets the ABIM had secretly funneled from unsuspecting ABIM diplomats' board certification and re-certification fees from 1989 to June 30, 1999 to the secret "American Board of Internal Medicine Foundation." (Author's note: In my opinion, the amount taken from practicing physicians may have been considerably more since the ABIM paid large fees to a high-risk investment firm, 1838 Investment Advisors, LLC that lost 74% of its value before it was quietly shut down. Only after an IRS name change was the undisclosed "ABIM Foundation" finally revealed to the public and practicing physicians in 1999. I believe the origination date and domicile of the Foundation was repeatedly misrepresented to the IRS from fiscal year 2009 to as late as the 2013 IRS Form 990 to obscure its origin. To the best of my knowledge and belief after piecing together available tax forms, the leadership and board of the ABIM authorized $80,278,428 to be taken from diplomats' testing fees to fund the ABIM Foundation in the form of contributions and grants from 1989 through 2007.)

After several years of meetings with members of sympathetic U.S. and European professional societies and leadership from the Robert Wood Johnson Foundation, the writing group from the ABIM Foundation achieved their goal. They published their missive entitled "Medical Professionalism in the New Millennium" in 2002 as a non-peer reviewed white paper in the Annals of Internal Medicine and Lancet with the help of sympathetic editors. Not surprisingly, many of the creators of this document have since left medicine to join the lucrative ranks of the insurance and retail pharmaceutical industry like Wellpoint and CVS.

Thanks to their growing avarice and their undisclosed political and health care policy activities, none of the leadership or board members of the ABIM found fault with the purchase of a $2.3 million condominium complete with a chauffeur-driven Mercedes S class town car in December 2007. According to Richard Baron, MD, such an "investment" was the norm for tax-exempt non-profit 501(c)(3) corporations. (The condominium expenses totaled $850,340 from December 2007 through June 30, 2013 (FY 2008: $42,522, FY 2009: $164,460, FY 2010: 161,957, FY 2011: $165,982, FY 2012: $161,980, FY 2013: $153,439)). In the email I received from him regarding this discrepency, Dr. Baron claimed that many of these "condo expenses" included the depreciation expense for the condominium, yet depreciation for the condominium was never claimed on any ABIM Foundation IRS Form 990 tax form until this fact was disclosed on these pages.

As the requirements to participate in Maintenance of Certification (MOC) mandated by the American Board of Medical Specialties (ABMS) grew, many physicians found the requirements little more than onerous busy-work exercises that distracted from patient care. Many practicing physicians elected to stall or not participate. For these reasons, the pressure on the ABIM to market the ABMS MOC recertification program and to protect their monopoly on the program increased. Many specialty societies, hungry for cash as physician participation at national scientific sessions waned, were increasingly happy to help the ABIM market MOC because of the revenue it generated for them.

ABIM's Director of Investigations

In 2008, it appears the ABIM hired a "Director of Investigations" to investigate physicians or individuals who they suspected might be stealing secrets from their proprietary certification process and disrupting their monopoly. A unique individual had surfaced that year that promised a return on their investment. He was perfect: someone with deep ties to law enforcement and surveillance techniques who had created a niche for himself in test security. He was comfortable collaborating with various law-enforcement organizations like the U.S. Postal Inspection Service and the FBI. His self-generated LinkedIn webpage (Author's addendum 9 June 2016 @ 20:00 PM CST: LinkedIn page has been brought down. Earlier partial copy can be viewed here or his Infragard info page should suffice. *** Author's Addendum: July 4, 2016: Mannes' LinkedIn page brought back up) impressive so few would question his integrity. But while this individual seemed perfectly amicable and credit-worthy on the surface, he held a more concerning past that the ABIM may have known but chose to ignore. Perhaps this is why his position and true background has never been formerly disclosed to physicians or the public. He appeared on the scene quietly at first with a press release concerning the existence of "phony boards" in AMA Medical News. A similar press release remains on the ABIM website. As others reportedly tried to capitalize on the board certification money pipeline, another warning of a fraudulent board scheme was circulated by the Connecticut Attorney General's office a short time later. In fact, according to my review of available Form 990 tax forms, this individual and the salary he receives from the ABIM has never been disclosed by the ABIM, yet he freely promotes his position at the ABIM with the movie and test security industries.

It was becoming abundantly clear: the ABIM meant business when it came to protecting their physician testing empire.

Teaching to the Test

With the exponential growth of information in health care, "knowing what to know" to pass a re-certification examination became more important than ever to practicing physicians. Not only were the insurance company and pharmaceutical company pre-authorizations adding to physicians' workload, certification requirements to remain employed were as well. By 2009, the demand for Board review courses that promised successful re-certification pass rates had skyrocketed. Because the stakes were so high and the content of the examination often obtuse, many physicians recognized that they could no longer just rely on their experience to pass the examination. Board review courses became a necessary pre-requisite for many to pass because hints and tips of what content to study were always provided, irrespective of which organization or individual offered them.

As the stakes for certification and re-certification grew, word spread that a doctor, Rajender K. Arora, MD was running an "Unusual Board Review" course that used content remarkably similar to study questions on the ABIM certifying examinations. They had heard he got most of his study materials from physicians that had already taken the test. Pass rates and course ratings from attendees of Arora's course were good. Many medical schools and hospitals, eager to report high board certification pass rates for their physicians to remain ACGME credentialed, recommended their residents and physicians attend this course. After all, the Arora Board Review had received ACGME accreditation.

But for the ABIM (and for their affiliated professional societies like the American College of Physicians that earn handsome returns from board review materials) who felt their databank of re-used test questions might become compromised and less valuable, something had to be done.

The Raid

So the ABIM tapped the skills of their "Director of Investigations." According to the original complaint of a suit filed under seal by the ABIM, an employee of the ABIM was tapped to attend (see items 43 and 48) and audiotape at least one of Arora's courses. The ABIM has retained this audiotape in their possession (partial transcripts of the recordings made by ABIM are included here, here, and here). It appears this evidence was used to help secure an ex parte Temporary Restraining Order and Seizure and Impoundment Order issued against Rajender K. Arora, MD, Anise Kachadourian, MD, and another 50 unnamed "John Doe's" in 2009. The complaint was filed "under seal" (not disclosed to the public initially). Only three names (other than the ABIM's counsel) appear on that order that supplied the judge with the evidence the ABIM had acquired: Christine Cassel, MD (President and CEO of the ABIM), Rebecca Baranowski (Senior Clinical Content Manager for the ABIM), and A. Benjamin Mannes (Director of Investigations for the ABIM). On the basis of the evidence obtained by the undisclosed ABIM employee (s), US Marshals executed a writ to seize materials from Dr. Arora's residence including copies of computer hard drives, backup tapes, Dr. Arora's cell phone as well as 36 boxes of course materials.

But what the Director of Investigations, A. Benjamin Mannes, (aka "Ariel Benjamin Mannes") likely failed to disclose to the judge (and still has never been fully disclosed in my own earlier personal email communications with him, other US physicians, or the public) is that Mr. Mannes carries two felony convictions. These convictions were issued Dec 13, 2005. According to District of Columbia felony conviction #006438 found on the DC Court Cases Online search web page, Mr. Ariel Benjamin Mannes, a former DC police officer released from the DC police force in 2003 after targeting a journalist who wrote a satire on dirty DC cops, was later convicted on charges of (1) impersonating a DC police officer and (2) carrying an unregistered firearm in 2005 after working as a bouncer "keeping the piece" (details at this link) at a local D.C. nightclub to supplement is income while working for the TSA, Railroad division. As a result of the night club incident, Mr. Mannes was released from the TSA in late 2007 just before apparently joining the ABIM. He lost his appeal of these convictions Oct 21, 2008 less than two months before he appeared (backup pdf of the webpage here) in the press as the "director of test security" for the ABIM.

This revelation is not a minor concern for practicing physicians and the public. Certainly using convicted felons for security jobs is not news. But the irony that a felon would be hired to tract the elusive physician thought to be cheating as they studied for a credentialing examination is lost on few.

Many other important questions remain. Did the ABIM call the police before initiating their investigation or use Mr. Mannes, a confirmed expert at intimidation, as a "law enforcement officer" to establish probable cause for the search and seizure at Dr. Arora's residence? What policy and process does the ABIM have to assure due process of physicians accused of cheating? Why was a press release issued before due process occurred? Why is his salary and position of someone this instrumental to physician "investigations" and intimidation not disclosed on ABIM tax forms or elsewhere? How much did (and does) Mr. Mannes earn for his "services" at the ABIM? Would the 139 physicians who were either sued, sanctioned, or vilified in the mainstream media for "cheating" without due process have had a very different outcome if Mr. Mannes' past history been brought to light? How many other of the "50 John Doe's" does the ABIM intend to sue based on Mr. Mannes' "investigation" work and how much will this cost practicing physicians? With whom did Mr. Mannes collaborate in law enforcement? Did Mr. Mannes' access to law enforcement assets allow him to track physician email addresses? What did he disclose to them and what did they disclose to him? Were the physicians struggling to remain credentialed to practice medicine after the ABIM's abrupt unilateral and highly lucrative certification rule change at fault or was the leadership and board members of the ABIM who instigated this attack on their character using a convicted felon? Who at the ABIM directed an "employee" to attend and secretly audiotape the Arora Board Review courses? Should attendees of Dr. Arora's course have been informed they were being audiotaped or did the ends justify the means? Were physicians' Fourth Amendment Constitutional rights violated because a law enforcement officer was not used to obtain the search and seizure order on Dr. Arora's residence? Was evidence manipulated? What right to privacy are physicians entitled that study for their MOC re-certification examination? Do physicians have a right to know that attendance at a board review course could be used against them if they mention question content they heard from others?

Considering the millions of dollars involved, the myriad of conflicts of interest, and use of a felon for Board certification and re-certification "investigations," who cheated whom in 2009?

Sadly, these concerns have not disqualified Mr. Mannes and the ABIM's former prosecuting attorney from ABIM's law firm, Marc Jacob Weinstein (with whom Mannes collaborated and who helped bring the original legal complaint against Dr. Arora in 2009) from serving leadership roles (or as employees) of the test security firm, Caveon and marketing their expertise to the Association of Inspectors General or test security conferences (page 19) as late as November, 2015. It is also concerning that Mr. Mannes' background allows him to serve as Governor on the Board of Directors of Philadelphia InfraGard. (For those unfamiliar, "InfraGard is a partnership between the FBI and the private sector created after the 9/11 terrorist attacks that is an association of people from businesses, academic institutions, state and local law enforcement agencies, and other participants dedicated to sharing information and intelligence to prevent hostile acts against the U.S." Doctors should note that Philadelphia InfraGard lists its address as the same address as the FBI in Philadelphia.)

I believe Christine Cassel, MD, who was President and CEO of the ABIM at the time, bears much of the responsibility for the actions and direction of the organization during her tenure. The day after publishing the ABIM press release about the ABIM's actions and the appearance of a simultaneous article in the Wall Street Journal on the matter, Dr. Cassel published a column on the KevinMD blog 10 Jun 2010 entitled "ABIM responds to doctors sharing board certification questions." The original link to the redacted Arora emails that the ABIM claimed formed the basis of their suits against physicians has since been removed. (I retrieved the emails from the internet archive here). In her column, Dr. Cassel explained: "through these actions we are taking, we are reassuring patients and the public that the can continue to trust the process and, and (sic) physicians can continue to trust that it is a fair and rigorous assessment of their medical knowledge and judgment." In retrospect, I believe Dr. Cassel had good reason to use strongman tactics and a convicted felon against more vulnerable physicians: to insist the income generated by physician re-certification be protected. In her 11-year history as President and CEO, to the best of my knowledge, she earned at least $10.88 million dollars, with nearly $9 million of that amount from fees paid diplomats of the ABIM. Dr. Cassel, who it appears was pivotal in organizing the raid on these physicians' residences for her financial and political benefit, was a member of the President's Council of Advisors on Science and Technology (PCAST) at the time and remains there today. PCAST is an advisory group of the nation’s leading scientists and engineers who directly advise the President of the United States and the Executive Office of the President. Not surprisingly, Dr. Cassel who ironically describes herself a "leading expert in geriatric medicine, medical ethics, and quality of care," does not participate in Maintenance of Certification despite being a founding member of the Institute of Medicine and the former President and CEO of the National Quality Forum that determines quality metrics for the nation's hospitals on behalf of the Center for Medicare and Medicaid Services. Given her long-standing conflicts of interest with Kaiser Foundation Healthcare and Hospitals, is there any wonder why she was appointed as Planning Dean for the newly-announced Kaiser Permanente School of Medicine as of March 1, 2016? What message will her history of intimidation and questionable ethics send to Kaiser's future medical students?

ABIM's Ongoing Legal Actions

Currently, the ABIM is involved in another suit they brought against Arora Board Review attendee, Jaime Salas Rushford, MD from Puerto Rico. According to the letter sent to Dr. Salas Rushford on May 8, 2012, the ABIM was "conducting an investigation into the practices of Arora Board Review and its customers." According to the letter, the ABIM traced emails they obtained from Dr. Arora's computers and on the basis of their discovery "determined to indefinitely revoke your certification and will notify the Medical Board in every jurisdiction in which you are licensed" without due process. Given what we now know about the practices of the ABIM and their "Director of Investigations," is there any surprise that Dr. Salas Rushford is having difficulty obtaining documents from the ABIM for his defense and for his countersuit against them? The foot-dragging and excuses made by the ABIM, including the possibility that Dr. Salas Rushford will make the settlement arrangement between Dr. Arora and the ABIM publicly available on his website, suggests the ABIM cut a special deal with Dr. Arora whom they never sued. What was that arrangement? Why has this not been disclosed publicly? How many other physician email addresses obtained from the Arora Board Review course computers does the ABIM still plan to track down and sue? How many millions of dollars have been squandered by the ABIM in legal attacks upon physicians attempting to fulfill the ABIM's unilaterally mandated re-certification requirements?

It is difficult to imagine a more Kafkaesque twist to US medicine's professional regulatory system. At least six physicians were sued as a result of the ABIM's raid on Arora's residence and 134 more sanctioned, resulting in untold professional ridicule, anxiety, embarrassment, and potential loss of their ability to practice medicine. No doubt their patients suffered, too. To add insult to injury, Ms. Lynn Langdon, then the Chief Operating Officer of the ABIM and a non-physician staff member of the ABIM who earned $681,152 in FY 2012 ($297,646 as a "bonus and incentive compensation"), sent thousands of "letters of concern" to other physicians who attended the Arora Board Review course and reportedly keeps those letters on file. Richard Baron, MD, the current President and CEO of the ABIM, earned $61,216 as Chair of the Directors at the time of the audiotaping of the Arora Board Review course and was surely was aware of the raid as well. Like the McCarthy era, it appears we have a system of regulators that will stop at nothing to intimidate and blackball physicians to assure funding of their regulatory cartel.

It is time for the public and our professional societies to know the truth. I believe, given these facts, that the ABMS MOC program (and any iteration that it might morph into) has no place in US medicine and should be abandoned immediately. I also believe the Wall Street Journal that published its earlier story in 2009 with the headline suggesting physicians "cheated" should publish a retraction and provide a follow-up investigation of the ABIM with these facts in mind to set the record straight. After all, the simultaneous release of the Wall Street Journal story the same day the ABIM press release was issued, coupled with the fact that physicians' names appeared in the article that did not appear in the press release, suggests the Journal was tipped to the story by the ABIM who sought to profit from their actions. To the best of my knowledge at this time, no physician that was sued by the ABIM as a result of the Arora raid has paid a dime in penalties to the ABIM for copyright infringement for attending the Arora course. Yet how much harm was experienced by the 139 physicians who were sued or sanctioned by the ABIM on the basis of the irresponsible actions of the ABIM and their felonious "Director of Investigations?" I know of at least one physician who received the ABIM's "letter of concern" has been unable to re-certify in any subspecialty since that letter was issued.

Moving Forward

It is time for a full investigation of the ABIM and its practices by the Department of Justice, Internal Revenue Service, or the Federal Trade Commission. Are the tactics, that have been used by the ABIM typical of a non-profit 501(c)(3) organization granted tax-exempt status? It will take time and resources to do so, but the public and practicing US physicians deserve to know the truth of all that has transpired and continues to transpire with our nation's physician regulatory system. Without such an investigation, it is hard to see how the ABIM or the ABMS will ever regain the trust of physicians or the public. Clearly, the status quo is unacceptable. If the ABIM and ABMS structure are to survive, bylaws must be changed to insist that an elected board will lead each subspecialty society in lieu of the appointed ones and membership of each organization must decouple themselves from the government and corporate interests that financially benefit the current system. A full independent financial audit as far back as 1986 as well with full disclosure of tax filing discrepancies is especially needed. Professional societies and academic journals who conspired with the ABIM and continue to support the ABMS MOC program for their financial benefit need a similar shake-up as well.

Physicians want to care for patients, we do not need unaccountable henchmen and bureaucrats hell-bent on their own power and profits to do our job. It will be up to each of us to demand that hospital systems and insurance companies no longer require ABMS specialty board "maintenance of certification" as an exclusive requirement for licensure, hospital admitting privileges, academic appointments, or insurance panel participation. If they do, it will be up to each of us to demand justice.

"It ain't what you don't know that gets you into trouble. It's what you know for sure that just ain't so."

39 comments:

Wes, they all knew what was going on at the ABIM from Wachter to Baron to Cassel! They all took part in this scandal and then moved on except Baron. He got a job for his roles. Look at the signature/names on COO Lynn Langdon's 2700+ letters of sanctions/reprimands that were mailed--all combined--to over 3000 physicians show that the ABIM executives and officers were all involved. The board as well.

What's more the entire ABMS umbrella knew and was involved at variously levels and member boards in this strongman racketeering and profiteering. It was/is not isolated to the ABIM. The ABMS shared their felonious Director of Investigations/surveillance and all the rest of their testing security police.

Richard Baron was one of those hit men calling the shots with Eric Holmboe, Christine Cassel, Lynn Langdon, Ben Mannes, Ballard Spahr, an so on. All of these people received fat paychecks, bonuses, deferred compensation and lucrative job offers in the revolving door network or companies/medical corporations they may have improperly assisted.

I would like to see the hiring documents for Mannes from the ABIM human resources department and see his contract and compensation. This is outrageous. The legal implications of their raid on Arora must be followed up on by physicians and the DOJ. I will not, and others should not, let the ABIM/ABMS get away with this travesty of justice.

Btw, in looking at pacer.gov court documents it appears that Mannes appears to have been hired in 2008 about the same time the ABIM was "cleaning house" and "setting up" for termination a couple tenured African American women in the human resources department. They may have had some input/information or voiced some concerns about the hiring of a double felon to do ABIM's dirty work. These women were bright, competent and honest. Maybe too honest for Christine Cassel, Eric Holmboe, Richard Baron, Bob Wachter and Lynn Langdon to trust or keep around.

Whistleblower types, perhaps in Langdon/Cassel's minds. These very dedicated, hard working and well respected women of color worked there a combined 24-25 years and gathered a lot of experience and knowledge of the ABIM. Langdon saw them as a threat as she had been at the ABIM longer than anyone. (44 yrs. when she disappeared from the ABIM without even a press statement mysteriously in 2016) These human resource managers were not only treated with indignity suddenly by their executives, but after they were terminated for no good reason they filed a lawsuit claiming discrimination against them by the ABIM, including Cassel and Langdon if my memory is correct.

There may be plenty of people at the ABIM who could come forward and fill in the gaps or would like to see justice served.

I would like to see justice served. I am so angry at the fraud and deceit. It is a house of cards truly. Who else did Baron and Cassel throw out the window who knew too much, besides these women of color in the human resources department?

Where's the DOJ? The federal court has been turned into ABIM's lapdog. Do they know what they have done? They must be informed. Look at the real facts and every physician has legal grounds to take the ABIM/ABMS to court.

I am amazed and appalled. The hiring of an individual convicted of a felony to police the educational efforts of thousands of honest practicing physicians is unconscionable. I believe that Dr. Baron be allowed to respond to the post. I am afraid however that organized medicine is so corrupt that only a class action law suit the plaintiffs' being ABIM certified physicians participating in MOC will shed any light on the murky operations of the ABIM.I am not posting this comment anonymously as i would yet like to believe that the ABIM is aware of the first amendment

Every physician and patient should read this! This is very important investigatory research from a journalist-physician who is knowledgeable on this subject and trusted by all. This should be required reading for medical students and residents as well. Get this out with a link in as many places as possible. It is frightening to think that the executives and board at the ABIM and ABMS would condone any of this. We need to take medicine and our country back.

Wes, I read you article. Impeccable work. It makes me even more disgusted with Cassel, Baron, Langdon, Holmboe, and Wachter, but suspected much of this from some of our own online research. I am sure many have conducted their own research as well in fact checking. Regardless, all this needs to be investigated thoroughly by impartial federal or state prosecutors. The facts centering around how ABIM bent the rules and most likely broke the law needs to come out in the courts properly.

Langdon, who was COO in charge of the testing security, did not dare put her name to the court document requesting the seizure of property. She must have hired her patsy Mannes to take the fall for her and Chris. He's going down. I hope he takes as many of the executives as he can with him. Looks like the ABIM is using compromised people all the way around in their legal and investigative activities.

By the way did you make screen captures or Word/PDF conversion file of ABIM's "Director of Investigations" LinkedIn pages? It appears the ABIM, Caveon, or the ABIM's Director (someone) has scrubbed his LinkedIn account clean. I understand this certification/testing scandal is more than just embarrassing for the ABIM and ABMS so they must be working hard to delete as many files and documents/links as they can.

You know they really should compensate physicians for the decades of lies, demonization of physicians, constitutional violations, criminal activities, and judicial tampering.

SummaryA. Benjamin Mannes is a specialist in the navigation of the vast public safety, homeland security, and high stakes testing (exam integrity) communities in North America with operational and leadership experience in law enforcement, investigations, emergency management and test security related business functions nationwide.

Experience• Director, Office of InvestigationsAmerican Board of Internal MedicineJune 2008 – Present (7 years 6 months)Greater Philadelphia AreaOversee security and exam integrity investigations regarding the medical certification process, board certification examinations, and assessments of the nation's largest medical specialty board, certifying approximately one in every four licensed physicians in the U.S. Coordinate investigations into the theft of trade secrets, copyright infringement, security leaks, and test fraud. Assists legal council and internal committees with the preparation and execution of legal and administrative actions relating to security & exam integrity issues.

(NOTE: Was on extended leaves of absence 9/03-11/07 and 6/08-6/09 when many of the below management opportunities were pursued)

• Principal Consultant & Technical Advisor/FounderMannes & Associates, LLCSeptember 2003 – June 2008 (4 years 10 months)Founder & principal of a consulting firm composed of a team of current and former federal, state, and local law enforcement officers who provide invaluable expertise, security consulting, security/threat assessment and technical advisory services to many areas of specialty, including the entertainment industry, news and media, manufacturers, non-profits and government contractors.

Physicians have been sheep to allow this to happen. The solution does not lie with lobbying legislatures and working towards deregulation. The solution is held by practicing physicians. If all of us stopped playing their certification game then market forces would quickly crush the ABIM and this corrupt oligarchy would cease to exist. I have twenty years of formal post high school education and I don't need their blessing to prove my worthiness to practice medicine nor my ability to pass an examination. Enough is enough, just say no.

The ABIM 1936 Articles stated and slated the corporation for administrative dissolution after fifty years or less. That would be 1986 or earlier. It is another irony that ABIM's non-profit time-limited mission was not honored. Instead after 50 years 1986 is when ABIM totally deviated from its voluntary mission to certify physicians. It is obvious ABMS propagated MOC in order to drain the bank accounts of every practicing doc.Physicians have been sheep to allow this to happen and need to dissolve the relationship with this "voluntary" certification corporation. The ABIM acts as though it was a law unto itself. The bubble of the ABMS has just been popped.

The AMA has a large and well-funded legal department. They also have a steady stream of law students and legal interns working for them. If they TRULY represented America's physicians, they would bring their significant legal resources to bear in seeing that this issue is presented to DOJ, IRS, etc. But they will not. They are AGAINST US, and in collusion with ABMS, ABIM, CMS, FSMB, etc. It's no wonder they will only grant Dr. Wes 15 minutes to present his case.

Wes, it is interesting that the slightly older version of Ariel Benjamin Mannes LinkedIn reference/CV shows how many corporate entities involved have been lying and covering up. They did make their guilt more obvious with the erasure of that LinkedIn account of ABIM Director of Investigations.

I did not know it was possible to just "disappear" a linked in account like that. I understand they have been trying to cover up ABIM's obvious relationship with Caveon and CEO David Foster and John Fremer for various reasons based on comparison of the recent version and the slightly older one you just posted on Twitter and here. http://www.caveon.com/our-team/

Caveon was partly responsible for Atlanta teachers going to prison for irregular erasures on children's state/nationally mandated testing. I believe that all of the teachers who were put on trial were African Americans. That looks bad for ABIM and Caveon's track record of discrimination imo. A poster wrote that the ABIM "disappeared" two African American women from the human resources department during the period when Mannes was hired. This whole ongoing scandal financial and criminal is just devastating for the "quality assurance" industry. Where is the Wall Street Journal now to demonize Christine Cassel, Lynn Langdon, and Richard Baron. This is real news and real wrongdoing. It shows how they may own the media.Remember how the media went after Kurt Eichenwald to intimidate him and his wife. Note that they used a conservative media for that! It is obvious about the testing/publishing industry has great control of the media when you consider that the only credible reporter (young inexperienced guy) who attacked Kurt Eichenwald was taken off his assignment following the Pope and handed an assignment with a script. Call him up and see if he will talk with you about it! How much power does the publishing/media industry have in this. A great deal. This is not just about the ABIM/ABMS. These people buy their insurance and even help push felon's through the system. Bury rap sheets by changing names slightly and insider influence.

So this is not just about testing/security, but it touches the whole healthcare industry. The lucrative business relationships and long running influence pedaling in the testing/security/publishing industry is a deep and sensitive one. There are billions of dollars at stake depending on how far wide this net of corruption runs. It puts the whole industry in the spotlight as there are major players that could get hurt. They will try their best to bury it. And yes there are compromised people that they control in high places with various forms of bribes and blackmail.

Note that the later modified version you first posted in your expose was a recent LinkedIn modification to downplay the stated fact that Mannes was holding two positions simultaneously as Director of Investigations--one at the ABIM/ABMS (Philadelphia/Chicago) and the other with Caveon in Utah. Your readers should know that Caveon's founder also founded Kryterion (Phoenix, Arizona) the online proctored testing/surveillance company that the ABMS has sponsored and still may use/consider for annual MOC testing. Your blog post has some insights on this and they were interesting to explore.

The plot and conflicts of interest thickens. It all gets thicker and deeper--more and more twisted and murky. Thank you for the light shed on this frightening activity and people in our lives that threaten not only ours, but everyone's civil liberties with their obvious criminal activity at the ABIM/ABMS. I am, as we all are, outraged and want an investigation of this and the industry to see how far this corruption goes and how far up the "chains of command!"

Answer this. Anybody. How can an individual just suddenly disappear a LinkedIn account like that? For what reason other than a cover-up of real wrongdoing?And just try to get a cached version of it. Let us know if anybody does manage to get a cached Google/Bing/Yahoo version of the LinkedIn CV of Benjamin Mannes aka Ariel B. Mannes.

How the hell did a two-count felon Benjamin Mannes--or whatever his real name is-- get a free pass into the FBI's InfraGard program? And how in the earth did he get propped up into being made a governor of Philadelphia's InfraGard Chapter! The access problems to sensitive information or people in the FBI who could give access is more than concerning. This puts a cloud over the whole InfraGard program that was designed for "Homeland Security" not spying on physicians, citizens, politicians, businesses! The conflicts of interest here go far beyond anything we an imagine. This guy Mannes and his bosses Lynn Langdon, Christine Cassel, and Richard Baron need to be deposed by the DOJ!

Here's a liberal news blog "dailykos" that our vice president Joseph Biden was a keynote speaker at (Netroots Nation). This article below slams the FBI/InfraGard for allowing access in the organization to convicts and how they miss making secure their own systems from sensitive information and felons. Corruption is the implicit conclusion and gaining access of data and control! Privacy advocates are livid about the compromising nature of InfraGard, which was formed as part of/in connection with the Patriot Act after 9/11.

Why do we tolerate this selfish greedy organization? Everyone knows its ethics, science and financial operations are soiled. Now we learn they hired goon-thug cops to enforce and expand the reach of their pay-for-play MOC. And they continue to use legal threat and strong-arm tactics to get us to yield to their repugnant medical politics!

How did the ABIM find Ariel Benjamin Mannes? Who initially interviewed him and where did that interview take place? Did he completely lie on his application about his lack of experience in test security?

He had zero experience and knew nothing about medicine or physicians from what I can gather. The only apparent qualifications for the job were his felony convictions and willingness to give out false information--as would be clearly evident on his application and CV. The online CV on LinkedIn, which was suddenly blanked-out yesterday, is utterly surprising how bold of a deceiver Mr. Mannes apparently is.

The question remains how a busted ex-DC cop with recent felony convictions made his way to Philadelphia in 2007 or 2008, after a short stint in sales with an Israeli security company, which sold highly specialized disaster and incident management systems in the US?

I'd be surprised if ABIM HR vetted Mannes. This may increase ABIM's liability to 100% for any damages claimed against the ABIM or its personnel. There is tremendous liability. What insurer would touch claims filed against ABIM involving such a fraudulent actor with faked background and expertise. It's shocking. ABIM's investigations offices fraudulent! It's incredulous! A fraud signed a document presented to a federal judge giving ABIM authority to raid a home and seize personal property. I wonder what J Curtis Joyner, the judge presiding over the copyright trials and signed the "ex-parte" writ to seize property would have done if he were informed of the true facts and circumstances.

Christine Cassel was in the White House as an advisor to the president, which is probably why she signed the legal document. Her influence and weight probably had a great deal to do with the judge bending rules for the ABIM and Ballard Spahr. As the writ was under seal Arora was powerless to fight it. He had no warning or personal attorney to preside over the seizure. If the judge was duly informed about Mannes' background and CV manipulations the risk and possible legal implications and embarrassment for the president of the United States would have been too great a risk for a judge to sign.

An astute conservative judge like Curtis Joyner would not have signed, imo, if he knew and had full disclosure of all the facts. But especially because of the obvious violations to constitutional rights of the physicians that would have and did result. ABIM did not follow a proper course legally. If they served Arora as would have been more in keeping with copyright infringement law it would have given a very different outcome for the ABIM. There would not have been endless cases against any of the physicians who were caught in ABIM and Mannes' ambitions and dangerous crosshairs.

I would suggest that a number of concerned parties call the Philadelphia police and have them inquire if Mannes or a family member in his household has a firearm in their possession for the sake of safety of ABIM personnel at 510 Walnut Street. What Dr. Wes has uncovered is extremely serous and I believe it would be prudent to investigate also whether Mannes has access to any firearms. He may be a danger to himself or others. This is not just an entertainment for bloggers I would hope. Dr. Baron should take the responsibility upon himself to do something. Apparently the ABIM follows this blog, so anyone there at the ABIM should follow up on this prudent suggestion and contact the police with your concerns.

The staff at the ABIM may not be safe if Mannes flips again and wants to injure himself or someone else. There must be a great deal of pressure on Mannes and I hope there is a psychologist involved. I consider the situation serious and it is incumbent for the ABIM to be responsible. The rights of individuals to be in a workplace that is free of harm trumps all other concerns for rights and privacy in this case.

Revelations such as these should be directed to proper authorities to process. Where are the police or FBI in all this. It is their domain and responsibility.People have already been harmed with little regard. It is likely that more will follow unless this thuggery is stopped at its source. Is Dr. Baron so out of touch that he does not see the danger to his staff and physicians, which he has unleashed into the medical communities. For God's sake Rich, do something and start talking to us about this. You may start a real conversation when you deal with this properly.

Wes,I am at a loss of words. How in the world does the ABIM and the ABMS condone this type of unsavory behavior as a deranged enforcement mechanism? This has totally spun out of control. For the ABIM to hire a defrocked police officer to repackage himself as a testing enforcer is precisely why the medical societies need to stay far away from ABIM MOC.

One wonders, how much more ABIM garbage is about to be revealed as we comb through the Internet?

An ex-parte writ to seize property granted to ABIM in December 2009. Unbelievable. That's where this fraud began! Does anyone know how hard that a "writ to seize" is to obtain in the United States in a civil copyright dispute. A sealed order even more rare. I've never heard of it myself. Extremely difficult if not impossible. Why is it so difficult. First of all and foremost. We have a constitution with amendments, particularly the 4th amendment which does not allow carte blanche fishing expeditions. And that is what ABIM v. ABR was--a big fishing expedition. Dr. Arora was not a threat to anyone especially the ABIM. He was their partner if anything and one of the most compliant of partners. No different than any other board review course, except he loved his students. This story should be presented the MSM for immediate release. Physicians should sue the ABIM to seek some reparations and immediate remedy for the gross evil deeds of the ABIM. I have not words for this kind of behavior against physicians. We understand that the ABIM has legal rights too, but we need an investigation and explanation for all this. If the DOJ does not jump on this we need an independent task force from within the federal government appointed immediately.

Mr. Mannes employment as a director of investigations for the ABIM (and apparently the ABMS) should have been disclosed to physicians, specialty boards, medical societies, and all clients of the ABIM. The public who has been put at risks should have been informed. Ariel Benjamin Mannes has engaged in public fraud along with the ABIM. Mannes' position and salary should have been listed on the ABIM and ABIM Foundation 990 tax filings. This is extreme fraud and it is a form of public fraud of the worst kind. This man, A Benjamin Mannes, aka Ariel B. Mannes defrauded all of us. He along with ABIM defrauded the federal courts--essentially lying/withholding facts to a federal judge along with Christine Cassel and Rebecca Baranowski. I would certainly include many other names to this fraud including Dr. Baron, Lynn Langdon, Eric Holmboe, seasoned board member Robert Wachter and others but we should be clear also that attorneys Hara Jacobs and Marc Weinstein with Ballard Spahr are also responsible for this as I have ascertained that both these attorneys involved take public credit for this miscarriage of justice on their personal and business websites. All these bad actors should be held accountable.

A cursory check of the American College of Forensic Examiners Institute website at http://www.acfei.com/forensic_certifications/ does not currently list certification programs in "Homeland Security" or "Sensitive Security Information", however review of the American Board for Certification in Homeland Security's website at http://www.abchs.com/certification/ lists available credentials in "Certified in Homeland Security (CHS) level I-V" with an exam that "was developed by a group of leading homeland security subject-matter experts" and "Sensitive Security Information, Certified (SSI)" with an exam "Designed by experts". Unfortunately, the verification tool on the ABCHS website has no evidence of Mr. Mannes as a member and sadly for Mr. Mannes, ABCHS eligibility requirements for these programs indicate "No felony convictions", so it's not clear if Mr. Mannes ever held these certifications, or once held them and subsequently lost them due to his felony convictions documented by Dr. Fisher above.

It is inconceivable that ABIM, an organization that self-proclaims standing for "the highest standard in internal medicine and its 20 subspecialties" and touts that it's credential - "Certification has meant that internists have demonstrated – to their peers and to the public – that they have the clinical judgment, skills and attitudes essential for the delivery of excellent patient care" has placed responsibility for "preparation and execution of legal and administrative actions relating to security & exam integrity issues" with an individual who is incapable of achieving or maintaining certification in his own self-described areas of expertise for reasons directly related to his own personal conduct and integrity.

Bravo, Dr. Baron. Just when I thought ABIM's credibility could not possibly sink any lower, I am proven wrong. Perhaps Dr. Cassel bears the initial and primary responsibility for placing Mr Mannes in the position of determining the ability of 200,000+ ABIM diplomates to practice medicine, but you are currently responsible for ABIM's actions and as Lee Iacocca once said many years ago, "The speed of the boss is the speed of the team".

Do what is right, Dr. Baron, while you still have an opportunity to do so. Before much more time elapses, it won't matter what you do or don't do, as these matters will be out of your hands.

In the current extension of Mr. Mannes and the ABIM's legal strong-arming from 2009, it is obvious that Dr. Salas Rushford is an innocent political/financial victim. His public persecution/prosecution is an extension of ABIM's fraudulent investigations and claims against physicians who attended competing board review courses.

I cannot wait for the deposition or Ariel B. Mannes in New Jersey as soon as they can locate him and/or he finally responds. I want to hear from Lynn Langdon as well Mannes direct boss and employee of the ABIM for decades.

I predict if/when facts are made known publicly the United States citizens will label the ABIM one of the most corrupt corporations in the history of the American medicine.

I have followed the court cases of ABIM versus so many physicans. These are wrong. They were based on fraudulent evidence and clealy political and financial motivations having nothing to do with protecting the public or copyright. Nothing whatsoever. I have looked into this thoroughly that is my assessment.

It is important discuss concerns with executives at the ABIM. Make appointments if necessary. Show them how you feel and what you think. Most of the physicians who are informed have very little good opinion of them. It is their own fault for cheating and lying behind our backs about MOC, the legal strong-arming, their fake professionalism, phony finances, money "transfers" to a hidden foundation, lobbying, and Choosing Wisely, and on and on.

It is also vital to show support/donate to Dr. Salas Rushford who is in a fight (our fight) to expose the ABIM and claim back his and all of our professional and personal lives. We have been put through the grist mill and suffered enough.We have had it with MOC. It is based on propaganda and lies with financial and political motives behind it.

Dr. Rico: I am very concerned. Yesterday, I contacted a very respected security certification board which Mannes claims to hold. I explained the situation to them and they responded with seriousness strongly suggesting that if anyone feels they are in danger from Mr. Mannes they should call the police immediately as it is not in their capacity to "police" their security certificate holders.

I was also informed that the officers and staff of their organization must follow their policies strictly. Anyone breaching ethics or policy among their executives or staff would face termination if they so much as breached a privacy policy.

They told me they have a protocol for filing a complaint/grievance against Mr. Mannes, also. I will make the information available to Dr. Wes at his email.

I will repeat what I was told: "I would suggest that people contact the police directly with any concerns for security, privacy, or bodily harm."

We cannot hold our breaths for Dr. Baron to address this with a personal email to diplomates and candidates informing us of what he is doing to remedy/assuage our fears and concerns for personal safety, privacy and security. I would recommend immediate termination/suspension without pay of Mr. Mannes. This is outrageous to retain such a person that has been responsible for so much harm to the entire body of the ABMS and individual physicians en mass.

Former Ballard Spahr Attorney Marc Weinstein claims to have obtained the ex-parte writ to seize Dr. Arora's property and physician files in ABIM v. ABR--along with Hara Jacobs. Weinstein teamed up with Mannes to work for and promote Caveon surveillance/test security and Caveon/Kryterion online proctored testing for the ABMS and ABIM. Marc Weinstein (Caveon Director of Investigations and Privacy) and Ben Mannes (ABIM Director of Investigations, Caveon Director of Investigations) ambitiously worked to push their expertise learned on the job persecuting and defrauding physicians--cheating them out of their rights to privacy, due process and other civil liberties. The result is the mess we are in today. Physicians have been financially fleeced and politically controlled by their "regulatory bodies" at the ABMS. Weinstein and Mannes assisted/promoted racketeering and product/services procurement of vendors they worked for and represented. There are many references proving this ABMS strategy and promotion of their secret police/legal strong-arming techniques for profit and control. Fear of loss of job/secret files are the rule of the day at the ABIM and ABMS so that any violations committed against physicians are tolerated or disregarded.

How about the late Friday evening e-mail informing all of us who are recertifying that we are now taking two additional hours of testing to validate their pre test questions!!!

We registered for this exam with the clear description that it was three sections as it always has been. Life is planned around these exams.Some individuals may have even made travel plans as testing centers are not always near them and require transportation that now must be changed to accommodate the new time. More expenses and inconveniences just because ABIM makes a change without the courtesy of asking. Springing and changing the process after registration is extreme poor communication , an ongoing concern that has been relayed multiple times.

There have always been "pre-test" questions in the exam. In fact, those of us in medical education do instruct that individuals should not fret in exam questions that seem difficult as they are probably test questions. Now over 25% of questions will be pre-test...Questions that have not yet been validated can create anxiety and a lack of confidence if you have several that are not as clearly written or have more than one possible answer compared with those that have been validated. Having helped test MOC questions in past, I have found that is often true.

We are being forced to two extra hours to assist ABIM to continue to create exams that many members no longer are in support of and have been asking ABIM to change. And that we were not even asked if you would like to participate in pretesting and receive communication AFTER we registered for the standard practice is another example of how disrespectful ABIM is to those who are choosing to do recertify. Is this even legal? Can one change the time, format and expectations after one pays? I thought bait and switch is illegal?

One would hope they would have asked whether we would like to participate to improve the exam. All the questions could be given as an optional section at end or distributed in sets of 30 at the end as a one hour extension. Why not engage the physicians rather than continue to enrage us?

ABIM just continues to do everything they can to alienate those of us dedicated to patients and advancing the knowledge of medicine. These tests have never assessed competency and their mode of test taking is outdated. This must end now.

So what now? None of my colleagues know or care about this. It is easier just to complete MOC and take the ABFM exam. Dr. Wes's research has uncovered horrible, shocking and disgusting stuff. But, as best I can tell it has not even caused a ripple. Why not? Because physicians like me are afraid to risk our jobs. Until employers, insurers, licensing boards and hospitals accept other forms of board certification what can the average physician do? We certainly can't expect this research to result in any meaningful political or legal attention, particularly if Clinton wins the election.

So what do we do. In the face of this clearly criminal, unethical and evil we remain essentially helpless. The AMA, the AAFP and their like are of no use to us and are likely just as knee deep in it as the ABMS. I am truly thankful to Dr. Wes for doing this work. I remain ready to do what I can but remain pessimistic that the rank and file can do anything.

What resource do regular physicians have to mobilize large numbers of us to change things? Doximity? It seems not.

This is one of the most important investigations and should be a top national and international news item. I hope the new Attorney General will get some complaints from folks about this and take some action.

Someone mentioned here, in a related topic, that ABIM's "Director of Investigations", the two-time felon, Mannes, was not certified in some areas of expertise he claims. To follow up on this important topic, I saw on Mannes' LinkedIn account he claimed to have an ASIS certification. I doubt this is true, but if it is true we have a serious breach of security industry standards.

I noticed that Mannes claims to be recertified with ASIS through 2019. Previously it was 2010-2016. ASIS offers three-year renewals of certification if one meets ongoing educational requirements, but it is not a game changer that affects employment or insurance payments like MOC. ASIS, formerly a prestigious security testing company has really damaged its reputation imo by accepting Mannes' application without proper scrutiny.

With this unwise action ASIS has proven itself to be unworthy of its reputation for protecting the public from fraud, graft, and racketeering. I take this very seriously as it is unclear whether ASIS is a victim of fraud or party involved in a money-making scam like the ABIM and ABMS, i.e., its own form of racketeering. This is startling if true, and there is evidence to support this thesis that we have a systemic breakdown of ethics and adherence to the rule of law.

So, with Mannes' claims to certification one must ask if any certification/recertification can be trusted? It appears there are many certification companies like ASIS out there just taking money from people, rubber stamping violent felons who have lied to the public about their past or kept it well concealed. Mannes is a profound example of this. Probably helped along by the corrupt system.

As a result of looking into this it is obvious ASIS has shirked it duties. They have fallen far short in the measure of public security from fulfilling their solemn responsibility to investigate their certificate holders in order to protect the public. Wes' startling revelation that InfraGard, where Mannes claims to be a governor, is in the same offices as the Philly FBI! Most disturbing.

In light of all this, I suspect ASIS may have been corrupted from within (and without) and can no longer be trusted. This is quite troubling to me as someone who has knowledge of the security industry. Mannes certification was set to expire in 2016 (looking at Mannes online CV some months back) and it appears to have been renewed for another three years, if we can believe Mannes' CV. And his CV is suspect as it withholds Mannes firings from public service twice and two felonies.

It appears that Mannes has information posted online according to his own whims and whatever image he wants to project. Such as Mannes' mania to project himself as a spokesperson/expert for the medical quality assurance industry, testing security, and even a spokes for the US police force. Ironically, we see Mannes has been propped up as to claim to represent himself as the best in the field of counter-terrorism, affiliated organizations and agencies like the DHS.

It is nothing short of terrifying to see such impersonation on a grand scale paid for by the ABIM and ABMS, where Mannes has been cross-disguising himself and hiring himself out to many of the ABMS medical boards making further undisclosed extra bucks fooling them as well. But nobody is fooled anymore by Mr. Mannes and Dr. Baron, his boss.

So, to conclude, this is not only a big stain on ABIM/ABMS, but a big dark blotch on the reputation of ASIS to allow a violent felon with a known history of intimidation and strong-arming reporters, physicians, and public to hold or claim to hold one of their (previously) prestigious security certifications. I would be screaming for an internal audit of this company ASIS which apparently has been giving their certifications out like candy to felons--real violent people like Mannes who have been convicted of serious crimes and utilized by the system to serve in unethical and unlawful ways unbefitting for the medical assurance industry. (Mannes plead guilty to gun violations and impersonating a police officer with aggravated assault charges dropped in a plea deal, just before being recruited by the ABIM/ABMS in 2008.)

I suspect, based on data I have seen, and the hiring of Mannes by the ABMS, that corruption is systemic in the security, testing, testing security, and quality assurance industries. The certification industry--with all the big money being milked out of clients in the recertification process--may be just one big scam. And the ABMS, with its unique monopoly within the medical quality assurance industry, has utilized the elements of corruption for their own purposes and not disclosed it on their tax filings--Chicago style.

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.